Provider Demographics
NPI:1043316649
Name:WARNER, ELIZABETH SCOTT (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:SCOTT
Last Name:WARNER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CATAUMET ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130
Mailing Address - Country:US
Mailing Address - Phone:857-576-0577
Mailing Address - Fax:
Practice Address - Street 1:450 LEXINGTON STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:AUBURNDALE
Practice Address - State:MA
Practice Address - Zip Code:02466
Practice Address - Country:US
Practice Address - Phone:857-576-0577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4124103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWAW04014OtherBLUE CROSS/BLUE SHIELD
MAWAW04014Medicare PIN